What is Infected Hair Follicle?
Medically termed as Folliculitis, this refers to a skin condition wherein there is an infection or inflammation of the hair follicles on the skin. The infected or inflamed hair follicles have the appearance of small swollen, pus-filled pimples . Folliculitis can occur in part of the body that has hair. The most common areas of infected hair follicle are face, scalp, and body areas which are rubbed by clothing like thighs and groin .
This is defined as the sac where hair growth happens . Located at the base of the hair follicle are the sensory nerve fibers which are wrapped around the hair bulb. These nerve fibers are stimulated when the hair is bent. This causes the person to sense that the hair has been moved. Aside from that, sebaceous glands are related to the hair follicles. The sebaceous glands are responsible for oil secretions which aids in conditioning the hair and the surrounding skin .
Picture 1: Hair Follicle Anatomy
Infected Hair Follicle Causes
- Bacteria: Infected hair follicle caused by bacteria is usually related to Staphylococcus aureus. This involves the deep part of the follicle which leads to painful boil.
Picture 2: Folliculitis caused by Bacteria
- Fungi: The ringworm of the scalp, the tinea capitis, mainly causes scaling and hair loss.
Picture 3: Folliculitis caused by fungal infection
- Yeasts: The most common yeast related to folliculitis is Pityrosporum ovale. It manifests as an acne-like condition which is itchy. This usually appears at the upper trunk of a young adult.
Picture 4: Folliculitis caused by yeast infection
- Another cause are infected cuts, scrapes, or surgical wound  and 
- This usually happens when the hair regrows after waxing, shaving, plucking, or electrolysis.
- This is common among women who frequently remove hair at their lower legs.
- Irritation also occurs from wearing clothes that rub the skin, or clothes which are tight.
- Another is the irritation caused by the pseudofolliculitis barbae. This occurs at the beard area of men. [2, 5]
Picture 5: Pseudofolliculitis barbae
3. Contact reactions
- Chemicals: coal tar, cutting oils. Also motor oil, cocoa butter, and creosote are included.
- Occlusion: mostly involves oil-based products, moisturizers, paraffin-based ointments, adhesive plasters. Other cause of occlusion or blocking of follicles is makeup.
- Topical steroids: The excessive use of topical steroids may lead to perioral foliculitis.
Picture 6: Perioral folliculitis
- Using whirlpool, swimming pool, or a hot tub that are improperly treated with chlorine. [2, 3, 5]
4. Inflammatory skin diseases
- Some inflammatory skin diseases results to permanent hair loss as well as scarring. Examples of these inflammatory diseases are discoid lupus erythematosus, folliculitis decalvans, and lichen planus. 
5. Suppressed immune system
- Eosinophilic folliculitis: this is common in immunosuppressed patients such as those with HIV or human immunodeficiency virus.
- Diabetes: This decreases the body’s ability to fight off infection. [2, 5]
- Protin kinase inhibitors
- B-complex vitamins 
Infected Hair Follicle Symptoms
The signs and symptoms of folliculitis vary based on the type of infection.
This type of folliculitis involves the infection or inflammation of the upper portion of the follicle. This may manifest as:
- Clusters of red or pus-filled bump which are small; these appear around the hair follicles.
- The pus-filled blisters that may break open and crust over
- Inflammation, redness, itchiness, or tenderness of the skin 
This type of follicultis begins in the deeper part of the skin which surrounds the follicle. Also, this involves the whole hair follicle. Signs and symptoms of deep folliculitis are:
- A large bump or mass which is swollen
- Blisters which are filled with pus, may also break open and crust over
- Pain at the involved area
- Scarring once the infection is treated 
Hot tub folliculitis
- This usually occurs 72 hours after soaking in a hot tub or being at the spa.
- It starts as small pimples located at the stomach, sometimes on arms and legs.
- Other symptoms include fever and stomach upset.
- This disappears on its own after 7 to 10 days. 
Picture 7: Hot tub folliculitis
Infected Hair Follicle Diagnosis
1. Physical Assessment
The doctor will assess the patient’s skin. The diagnosis will be based on how it appears. 
2. Medical Interview
The doctor also includes interviewing the patient about his health and current activities. 
3. Laboratory exams
- Microbial Culture: Obtaining the microbial culture aids in detecting if the infection or inflammation has a bacterial cause.
- Potassium Hydroxide: This involves pulling out some affected hairs. Then, these are examined using the microscope with the agent potassium hydroxide. This detects fungal infection.
- Skin biopsy: this aids in confirming the diagnosis 
Infected Hair Follicle Treatment
1. Mild Cases
Most mild cases of folliculitis go away without any treatment. This usually takes 7-10 days to clear.
- Warm compress: This is comprised with white vinegar or Burow’s solution. This eases the itchiness and enhances healing.
- Medicated shampoo: This is indicated for treating folliculitis on the scalp or beard.
- Moisturizer (emollient): This contains antibacterial agent which can improve the condition of the skin and ease the irritation. It also clears the folliculitis easily and quickly. This can also be used as a soap substitute until the hair follicle infection disappears.
- Antibiotic cream: This is helpful for localized type of folliculitis. An example is Fusidic acid which is very suitable to these cases. It is advised to be applied 3-4 times a day to the affected areas. [1, 2]
2. More Severe Cases
- Most doctors would prescribe antibiotic tablet treatment for patients with more severe or widespread folliculitis. 
Infected Hair Follicle Prevention
1. Good Personal Hygiene
- This is the most important preventive measure against folliculitis. It is a must especially in hot humid conditions, also in situations where this may lead to transmission of folliculitis from person to person (locker rooms, showers).
- Take a bath daily with the use of mild antibacterial soap. Make sure to take a bath or shower especially after exercising or having contact with chemicals.
- Avoid sharing personal items such as razors and towels. For the patients with folliculitis, it is recommended for them to use clean washcloth and towel when taking a bath.
- Keep the affected area always clean.
- Avoid the use of contaminated items. [3, 4, 8]
2. Avoid use of irritating chemicals
- Do not use oils on the skin. Oils promote accumulation of bacteria in the skin pores which causes folliculitis. 
3. Proper skin care
- Shaving: Refrain from shaving the affected areas. If shaving is necessary, try to change the razor blade every time it is done. Also, use depilatory creams and lotions. These products can remove hair with shaving. These are recommended to be used only once or twice a week.
- Use oatmeal lotion or hydrocortisone cream: The use of these agents helps in soothing skin itchiness.
- Do not scratch the bumps on the skin.
- Always keep the skin moisturized and protect it from damage. [1, 2, 6]
4. Use of proper clothing
- Avoid tight or constrictive clothing. Examples are jeans and athletic wear. This may chafe the skin. 
5. Avoid public tubs or spas
- If this cannot be avoided, shower right away with antibacterial soap.
- If tub or pool is owned, make sure to always keep it clean. 
6. Diabetes control
- One of the causes of folliculitis is diabetes. Make sure that patients with diabetes know how to control their condition, particularly their blood sugar levels. 
Points to Consider
Infected Hair Follicle or Folliculitis is a very common condition that could affect the areas of our skin which has hair growth on it. Usually, this condition clears by itself after 7 to 10 days. For those patients whose folliculitis doesn’t go away after that span of days, try the simple remedies, such as warm compress, medicated shampoos, antibacterial soap, oatmeal lotions, or hydrocortisone creams. Seek medical advice if the infection or inflammation still doesn’t go away. The doctor may prescribe other treatment.
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